Basic Information
| Provider Information | |||||||||
| NPI: | 1447256243 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HIGHLAND RIVERS COMMUNITY SERVICE BOARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1503 N TIBBS RD | ||||||||
| Address2: | |||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307202915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062705033 | ||||||||
| FaxNumber: | 7063707749 | ||||||||
| Practice Location | |||||||||
| Address1: | 1503 N TIBBS RD | ||||||||
| Address2: | |||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307202915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062705000 | ||||||||
| FaxNumber: | 7062705111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 11/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | DALLAS | ||||||||
| AuthorizedOfficialFirstName: | MELANIE | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7062705000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 11/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | N | Agencies | Day Training, Developmentally Disabled Services | 320800000X | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 332BC3200X | GA | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1174686620 | 01 | GA | SUBPART NPI | OTHER | 1578626917 | 01 | GA | SUBPART NPI | OTHER | 1043373467 | 01 | GA | SUBPART NPI | OTHER | 1093878464 | 01 | GA | SUBPART NPI | OTHER | 1538222971 | 01 | GA | SUBPART NPI | OTHER | 1093879827 | 01 | GA | SUBPART NPI | OTHER | 1285798041 | 01 | GA | SUBPART NPI | OTHER | 1881758613 | 01 | GA | SUBPART NPI | OTHER | 1912060088 | 01 | GA | SUBPART NPI | OTHER | 300030794B | 05 | GA | MEDICAID | 1083777650 | 01 | GA | SUBPART NPI | OTHER | 1164585543 | 01 | GA | SUBPART NPI | OTHER | 1669536991 | 01 | GA | SUBPART NPI | OTHER | 1740343300 | 01 | GA | SUBPART NPI | OTHER | 1861555450 | 01 | GA | SUBPART NPI | OTHER | 1023172350 | 01 | GA | SUBPART NPI | OTHER | 1629131214 | 01 | GA | SUBPART NPI | OTHER | 1689737033 | 01 | GA | SUBPART NPI | OTHER |